American Heart Association Comment On New England Journal Of Medicine Report OnCalcium Antagonist Nisoldipine (March 5 issue)

A study in the NEJM titled "The effect of nisoldipine as compared with enalapril on cardiovascular outcomes in patients with non-insulin-dependent diabetes and hypertension," finds an increased risk of fatal and non-fatal heart attacks among individuals taking the calcium antagonist nisoldipine compared to individuals taking enalapril, which is a member of a class of drugs called ACE-inhibitors.

The study provides more evidence that calcium antagonists (preferred term for calcium channel blockers) may pose risks for certain people, including those with diabetes and coronary heart disease. Past studies of short-acting calcium antagonists have also found increased risk of cardiovascular complications. It was thought that the longer-acting drugs did not pose similar risks. However, the current study used a long-acting drug.

Speaking for the American Heart Association, Joseph Izzo, M.D., says "individuals taking calcium antagonists should not panic and stop medication without consulting a physician. However, individuals with both known cardiovascular disease and diabetes may want to talk to their physicians about choosing another type of high blood pressure drug, or to use the calcium antagonist in combination with other agents that are complementary." Izzo is a member of the American Heart Association's Continuing Education Committee.

Calcium antagonists dilate (relax) constricted blood vessels and thus reduce blood pressure. However, this vasodilator action may force the heart to pump harder and may also stimulate stress hormones. This action is the opposite of beta-blockers that limit cardiac output, notes Izzo, professor of medicine and pharmacology at the State University of New York, Buffalo.

The study, by Raymond Estacio, M.D., of the Colorado Prevention Center, Denver, included 470 individuals who had high blood pressure and non-insulin dependent diabetes. The trial compared an ACE-inhibitor with a calcium antagonist in the p

Contact: Carole Bullock
American Heart Association

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